Analysis of deep anterior lamellar keratoplasty efficacy in keratoconus treatment: surgical and refractive outcomes

Purpose. To evaluate the efficacy and safety of deep anterior lamellar keratoplasty (DALK) in the treatment of advanced keratoconus. Materials and Methods. A retrospective study of 30 patients (30 eyes) aged 22–67 years with advanced keratoconus who underwent DALK between 2023 and 2024 at the Republican Specialized Scientific and Practical Medical Center for Eye Microsurgery, Tashkent, Uzbekistan. Intraoperative complications, uncorrected (UCVA) and best corrected visual acuity (BCVA), refractive parameters, topographic indices, and contrast sensitivity were assessed preoperatively and at 1 week, 1 month, 6 months, and 1 year postoperatively. Results. Successful pneumatic dissection was achieved in 90% of cases. Intraoperative Descemet's membrane (DM) perforation occurred in 10%, early epithelial defect in 20%, DM folds in 25%, Urrets-Zavalia syndrome in 10%, subepithelial haze in 20%, and anterior cortical cataract in 5%. BCVA ≥0.5 was achieved in 85% of patients at 1-year follow-up. Maximum keratometry (Kmax) decreased significantly from 88.23 ± 1.28 D to 52.53 ± 1.47 D (p<0.001). Mean spherical equivalent was –2.6 ± 1.49 D. Graft transparency was maintained in 100% of eyes with no rejection episodes. Conclusion. DALK is a highly effective and safe surgical treatment for advanced КС, providing significant improvement in visual and refractive outcomes while preserving the host endothelium and minimizing immunological rejection risk. Keywords: keratoconus; deep anterior lamellar keratoplasty; DALK; corneal transplant; big bubble technique; refractive outcomes

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